Windhoek — The Ministry of Health and Social Services says there was no negligence in the delivery of Rebekka Tjombe's baby, after the mother was instructed to take abortion pills to induce labour in her complicated pregnancy. But in a rare medical situation to save only the mother at the expense of the infant the baby also came out alive.
Speaking to New Era, the ministry's senior public relations officer Ester Paulus said investigations of the incident found that the way the doctor treated the patient was in accordance with the prescribed standing health procedures.
"It was indeed emotional and sensitive when the baby came out alive while they were expecting it to be dead, but there was no negligence, the treatment was according to the norm," Paulus said. She added that both the mother and the baby are doing very well and that chances of survival for the baby are very high.
Tjombe was admitted to the Katutura casualty ward on October 14 with leaking fluid, a situation the attending doctor felt endangered her life. She was then examined in the gynaecology ward and an abdominal examination ascertained she was pregnant but it was difficult to determine the exact duration of the pregnancy because of the absence of amniotic fluid in the uterus.
Paulus said an ultrasound was done that showed the patient had severe oligohydramnios due to premature pre-labour rupture of membranes. The diagnosis of inevitable miscarriage was made, IVI antibiotics initiated and the patient was admitted to the Windhoek Central Hospital. Oligohydramnios is a condition in pregnancy characterized by a deficiency of amniotic fluid.
Relevant questions were asked to determine the gestation of her pregnancy and the patient gave the same as the admitting notes, which was five months. The doctor repeated an ultrasound on her and confirmed severe oligohydramnios and explained to the mother what problems she and the foetus faced.
"The patient was asked to buy misoprostol which is not readily available in hospital because it is scarcely used. She went back to her room and called her husband who immediately came. The doctor explained again to both the husband and wife what had happened and what the examinations had found," Paulus told New Era.
Paulus said the chances of the mother picking up an infection were explained to her, as well as the chances of the baby dying in utero and the baby dying after the patient delivered due to prematurity. The couple said they understood and the husband went to buy the medication.
The prescribed medication was administered at around 12pm and the attending nurses informed the doctor in the evening that Tjombe had delivered a live baby weighing 1.5kg.
Nurses were instructed to contact the Premature Unit and call the doctor on duty for either a paediatrician or gynaecologist to attend to the baby and the mother. Paulus said the doctor explained to the patient the nature of the medical problem and the possible complications to forestall possible charges of professional negligence being made at a later stage.
Asked if any disciplinary action would be taken against the doctor, Paulus explained that due to the severe condition faced by Tjombe it was necessary that labour should be initiated and the product of conceptus including the foetus delivered in order to prevent an infection called chorioamnionitis that could be fatal to the life of the mother. Paulus strongly believes the doctor handled the case with due diligence.
"However had the patient informed the doctor that she was about seven months pregnant rather than five months then probably the patient would have been admitted to the maternity ward that is closer to neonatal ICU. If the patient is sure of her date and the uterine size corresponded to the date given by the mother, the patient is admitted to the right ward (gynaecology ward). Whether the size of the foetus is premature or very premature the mode of management is the same. In the presence of oligohydarmnios and potential presence of infection, the foetus and the placenta need to be delivered through induction (initiation of labour) unless there is a contra-indication (e.g. previous uterine scar)," she explained.
Paulus said the Ministry of Health and Social Services would sit down with the family and explain the whole process and also wanted to inform the public that hospital staff correctly dealt with the condition the patient came to seek help for (pre-labour rupture of membrane).